Janet Meredith, MBA, (left) with second-year medical student Megan Kalata.
(May 2017) When Jackie To came to the University of Colorado, she committed to
four years’ intense study at the School of Medicine, then augmented her
training by joining C-STAHR.
Through research, education and
advocacy, C-STAHR (Community-Students Together Against Healthcare
Racism) offers Anschutz Medical Campus students a deep dive into the
health concerns of neighboring communities to learn about health
“I have never heard of a group that works this
closely with the community at every step of the decision-making
process,” said To, who will graduate in May from the CU School of
Medicine. “It was very appealing that we would be forming relationships
at a very grassroots level.”
A group of medical students began
C-STAHR after hearing Salud Clinic Director Tillman Farley, MD, a CU
School of Medicine alumnus of the class of 1987, give a presentation
about health disparities. The students partnered with 2040 Partners for
Health, a health care advocacy group representing Northwest Aurora, East
Montclair, greater Park Hill, Northeast Park Hill and Stapleton
neighborhoods. C-STAHR members use community-based participatory
research techniques to ensure residents are involved in all aspects of
the research process.
“I immediately fell in love with the idea
that we could actually go about making some sort of difference in the
way doctors interact with patients,” To said. “But the reason I kept
coming back to C-STAHR was the community members, quite honestly. I
felt like I had never really had that kind of exposure before.”
Students learn about human biology at a Health Esteem futuRe
pOwer Encouragement Speak up (HEROES) event.
addition to conducting research, C-STAHR students created the Health
Esteem futuRe pOwer Encouragement Speak up (HEROES) program, which
educates minority high school students about health-care careers. Others
are involved in addressing the CU School of Medicine’s curriculum so
that it reflects more diversity.
Meanwhile students initiated
other projects using the C-STAHR model under the umbrella of 2040
Community-Based Student Program including research focused on
maternal-child health, teen obesity and alcohol use in the Burmese
Now in its sixth year, 2040 Community-Based
Student Programs, which includes C-STAHR, has 61 students (and 19
graduates) from the schools and colleges of medicine, pharmacy, nursing
and public health. The projects ask for a four-year commitment from
medical students, who receive training in leadership, grant writing and
research, said Janet Meredith, MBA, senior clinical instructor in the
Department of Family Medicine and director of student programs at 2040
Partners for Health.
“They really get to know people who are
different from themselves,” Meredith said. “When they hear a woman talk
about her experience with segregation … (or) a community member who lost
two sons at the hands of Denver police and a daughter who died of
pneumonia because it was too expensive to go to the hospital, they get
an education in a way that they will never pick up in a book.”
Maternal Child Health Project
Kalata, a second-year medical student, became interested in pediatrics
because of research showing that children who are healthy when they
begin school at age 5 are likely to continue in good health.
“It’s a lot harder to catch up later on,” she said.
casting around for a project, she was concerned by studies showing
that babies born to African-American women are three times as likely to
die compared to those born to white mothers.
The studies showed
that the results were not affected by age, education or socio-economic
factors, but rather indicated that levels of stress-related cortisol are higher in African-American women.
February 2016, she organized focus groups to ask African-American women
about their health-care experiences during pregnancy.
time we met I learned something different, and I started hearing a lot
of things repeated that I wouldn’t have thought about.”
that emerged was the reception African-American women received in their
first prenatal visit. About half the women said their health-care
provider recommended an abortion.
“Now, some were young – teens
even – but others were in their 30s, engaged to be married, and had a
stable life. Some were in graduate school.
“Another common theme
was their personal level of comfort talking to a provider and feeling
judged and not feeling like they can ask good questions. We’re trying to
tease out if that happens with all providers including doulas, doctors
Improving Patient-Provider Communication
When Jackie To’s father had a stroke during a family vacation, he encountered verbal abuse from the emergency doctor.
family had been vacationing in Nevada when the stroke occurred, but
their insurance only covered him in California. To and her parents knew
that quick treatment was important for her father’s recovery, but they
also knew they couldn’t afford treatment without insurance.
we showed up at the emergency room in California, the doctor started
screaming at us about how we shouldn’t have waited. He said we should
have just gone to the first emergency room we found. It was terrifying. I
was 19, and I spoke up for my dad and told the doctor that would have
bankrupted us so we intentionally made that decision. We took a chance.”
physician’s demeanor changed when he realized that, unlike her
immigrant parents, she could speak English well. He asked her about
school, and she told him she was a freshman at Stanford University.
that I was treated differently than my parents. If I hadn’t been there,
I expect the encounter would have gone very differently. I think about
all the other families out there who don’t have a daughter accompanying
them to an emergency room; a daughter who speaks excellent English and
is going to Stanford.”
Her research project at C-STAHR is meant to
help people like her parents. Students and community members decided
to focus on patient-provider communications after hearing patients complain about doctors ignoring them during visits.
To is sympathetic to both patients and providers.
have a specific agenda to get through and a limited amount of time to
do it. That can make them curt and impatient. In that encounter you
might feel the doctor is rushing you through and not addressing the
things you’re actually concerned about. That makes you feel like
you have no power. So the time crunch causes miscommunication and
Using a survey tool, the team
asked patients to prioritize their concerns so they can be mentally
prepared for their visit. Team members also encouraged the patients to
be assertive. “You have the right to speak up!” she said.
Through focus groups, To learned how important a doctor’s language and communication style can be.
“Working with community members made me hyper-aware that things you say can be misinterpreted.”
Benefits for Students
Community-Based Student Program research will continue after To, Kalata
and other students have graduated because other students will advance
the studies with the help of community members.
and noteworthy is that the students really own the program,” says Frank
DeGruy, MD, MSFM, chair of the Department of Family Medicine. “Faculty
help navigate things like Institutional Review Board policies, but
students set the agenda.”
The program has proved to be an
important recruiting tool for incomng students interested in community
work, said Shanta Zimmer, MD, associate dean for the Office of
Diversity and Inclusion. And participants tend to experience successful
residency matches, Meredith said. Between 2014 and 2016, all but one
graduating medical student placed in their first choice for residency.
of the things that the institution gets out of this is that we as
faculty have these students who are role modeling incredible commitment
to advocacy and community engagement,” Zimmer said. “Being a physician
is more than the facts they are learning in medical school. It’s a
lifelong commitment to service. The partnership comes from the community
and reminds us all again that it’s not just the things we’re studying
but also what we’re learning from patients. They teach us well.”